Abstract: SA-PO250

The Long Term Outcome and Histological Transformation of ISN/RPS Class II Lupus Nephritis

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Alsuwaida, Abdulkareem, King Saud University, Riyadh, Saudi Arabia
  • Bakhit, Amaar Ahmed, King Saud University Medical City, Riyadh, Saudi Arabia
  • Husain, Sufia, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
  • Alsuwaida, Feras Abdulkareem, King Saud University, Riyadh, Saudi Arabia
  • Wadera, Junaid, KING KHALID UNIVERSITY HOSPITAL, RIYADH, Saudi Arabia
  • KFoury, Hala M., KSU-KKUH, Riyadh, Saudi Arabia
Background

There are discrepancies on the guidelines of the treatment of Class II LN due to the lack of scientific evidence. The role of immunosuppression, however, is less clear. The primary objective of this study is to assess the response of immunosuppressive therapy, the long-term prognosis and the histological transformation to other ISN/RPS classes among those who underwent a repeated biopsy.

Methods

A retrospective study was carried out that included patients who had received a diagnosis of LN class II on their first renal biopsy, between the years 1996 till 2016. The rate of complete remission, defined as Proteinuria less than 0.3 gm per day, with normal creatinine 6 month after biopsy were also evaluated. We also compared the histological transformation among those who underwent a repeated biopsy during the follow up.

Results

The study included 32 female patients with SLE and class II LN with the mean age of 31.2 years. The most frequent presentation (72%) was asymptomatic hematuria and/or subnephrotic range Proteinuria. The median serum creatinine and proteinuria at presentation were 78 umol/l and 0.8 gm per day, respectively. Acute kidney injury was noted in 7 patients (22%) and 3 patients (9.4%) had a nephrotic range proteinuria. The management was steroid alone in 25 patients (78%), Mycophenolate Mofetil in 6 patients (18.8%) and cyclophosphamide in 1 patient. Among the 25 patients treated with prednisolone alone (0.5-1 mg/kg), complete remission was seen in 23 patients (92%). After a median follow up of 8 years, two patients doubled their serum creatinine. The repeated biopsy was done in 17 patients (53%) and the detail of transformation to other classes is shown in table 1. The repeated biopsy showed transformation to other classes in 11 patients (65%).

Conclusion

Daily steroid monotherapy may be an appropriate first-line treatment for class II LN. Larger, prospective, trials are needed to validate this strategy and identify those patients who are less likely to obtain remission.

Table 1. ISN/RPS classifications on repeat biopsy among 17 patients with baseline ISN/RPS Class II Lupus Nephritis
ISN/RPS IIISN/RPS IIIISN/RPS IVISN/RPS VI
6 patients (35.3%)5 patients (29.4%)4 patients (23.5%)2 patients (11.8%)
    

Funding

  • Government Support - Non-U.S.